Universal API Implementation Guide
1.1.19 - ci-build

Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions

Resource Profile: UAPI Coverage

Official URL: https://fhir.developer.gene.com/StructureDefinition/uapi-coverage Version: 1.1.19
Active as of 2021-06-03 Responsible: Genentech USIX PE Realm: United States of America flag Computable Name: UapiCoverage

This profile constrains the Coverage resource

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... PlanYear 0..1stringUAPI Coverage Plan Year
URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
... ReferenceNumber 0..1stringUAPI Coverage Reference Number
URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
... type S1..1CodeableConceptCoverage category such as medical or accident
... subscriber 1..1Reference(UAPI Patient | UAPI RelatedPerson)Subscriber to the policy
.... reference 0..1stringPatient or RelatedPerson resource UUID
... subscriberId S0..1stringID assigned to the subscriber
... beneficiary 1..1Reference(UAPI Patient)Plan beneficiary
.... reference 0..1stringPatient resource UUID
.... type 0..1uriType the reference refers to (e.g. "Patient")
Required Pattern: Patient
... payor 1..*Reference(UAPI Organization)Issuer of the policy
.... reference 0..1stringPayor Orginization resource UUID
.... type 0..1uriType the reference refers to (e.g. "Patient")
Required Pattern: Organization
... class S1..*BackboneElementAdditional coverage classifications
.... type
..... coding 1..1CodingCode defined by a terminology system
...... system 1..1uriIdentity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
...... code 1..1codeSymbol in syntax defined by the system
.... name 1..1stringHuman readable description of the type and value
... order S1..1positiveIntRelative order of the coverage
... network S1..1stringInsurer network

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... PlanYear 0..1stringUAPI Coverage Plan Year
URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
... IssuedDate 0..1dateUAPI Coverage - Card issuance date
URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ1..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... subscriber Σ1..1Reference(UAPI Patient | UAPI RelatedPerson)Subscriber to the policy
.... reference ΣC0..1stringPatient or RelatedPerson resource UUID
... subscriberId SΣ0..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(UAPI Patient)Plan beneficiary
.... reference ΣC0..1stringPatient resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Patient
... payor Σ1..*Reference(UAPI Organization)Issuer of the policy
.... reference ΣC0..1stringPayor Orginization resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Organization
... class S1..*BackboneElementAdditional coverage classifications
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

..... coding Σ1..1CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
...... code Σ1..1codeSymbol in syntax defined by the system
.... value Σ1..1stringValue associated with the type
.... name Σ1..1stringHuman readable description of the type and value
... order SΣ1..1positiveIntRelative order of the coverage
... network SΣ1..1stringInsurer network

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.beneficiary.typeextensiblePattern: Patient
Coverage.payor.typeextensiblePattern: Organization
Coverage.class.typeextensibleCoverageClassCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): IETF language tag

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... PlanYear 0..1stringUAPI Coverage Plan Year
URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
... ReferenceNumber 0..1stringUAPI Coverage Reference Number
URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
... IssuedDate 0..1dateUAPI Coverage - Card issuance date
URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for the coverage
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ1..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber Σ1..1Reference(UAPI Patient | UAPI RelatedPerson)Subscriber to the policy
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringPatient or RelatedPerson resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... subscriberId SΣ0..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(UAPI Patient)Plan beneficiary
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringPatient resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Patient
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... dependent Σ0..1stringDependent number
... relationship 0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ0..1PeriodCoverage start and end dates
... payor Σ1..*Reference(UAPI Organization)Issuer of the policy
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringPayor Orginization resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Organization
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... class S1..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

..... id 0..1idUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ1..1CodingCode defined by a terminology system
...... id 0..1idUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
.... value Σ1..1stringValue associated with the type
.... name Σ1..1stringHuman readable description of the type and value
... order SΣ1..1positiveIntRelative order of the coverage
... network SΣ1..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.subscriber.typeextensibleResourceType
Coverage.beneficiary.typeextensiblePattern: Patient
Coverage.relationshipextensibleSubscriberRelationshipCodes
Coverage.payor.typeextensiblePattern: Organization
Coverage.class.typeextensibleCoverageClassCodes
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... PlanYear 0..1stringUAPI Coverage Plan Year
URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
... ReferenceNumber 0..1stringUAPI Coverage Reference Number
URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
... type S1..1CodeableConceptCoverage category such as medical or accident
... subscriber 1..1Reference(UAPI Patient | UAPI RelatedPerson)Subscriber to the policy
.... reference 0..1stringPatient or RelatedPerson resource UUID
... subscriberId S0..1stringID assigned to the subscriber
... beneficiary 1..1Reference(UAPI Patient)Plan beneficiary
.... reference 0..1stringPatient resource UUID
.... type 0..1uriType the reference refers to (e.g. "Patient")
Required Pattern: Patient
... payor 1..*Reference(UAPI Organization)Issuer of the policy
.... reference 0..1stringPayor Orginization resource UUID
.... type 0..1uriType the reference refers to (e.g. "Patient")
Required Pattern: Organization
... class S1..*BackboneElementAdditional coverage classifications
.... type
..... coding 1..1CodingCode defined by a terminology system
...... system 1..1uriIdentity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
...... code 1..1codeSymbol in syntax defined by the system
.... name 1..1stringHuman readable description of the type and value
... order S1..1positiveIntRelative order of the coverage
... network S1..1stringInsurer network

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... PlanYear 0..1stringUAPI Coverage Plan Year
URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
... IssuedDate 0..1dateUAPI Coverage - Card issuance date
URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ1..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... subscriber Σ1..1Reference(UAPI Patient | UAPI RelatedPerson)Subscriber to the policy
.... reference ΣC0..1stringPatient or RelatedPerson resource UUID
... subscriberId SΣ0..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(UAPI Patient)Plan beneficiary
.... reference ΣC0..1stringPatient resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Patient
... payor Σ1..*Reference(UAPI Organization)Issuer of the policy
.... reference ΣC0..1stringPayor Orginization resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Organization
... class S1..*BackboneElementAdditional coverage classifications
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

..... coding Σ1..1CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
...... code Σ1..1codeSymbol in syntax defined by the system
.... value Σ1..1stringValue associated with the type
.... name Σ1..1stringHuman readable description of the type and value
... order SΣ1..1positiveIntRelative order of the coverage
... network SΣ1..1stringInsurer network

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.beneficiary.typeextensiblePattern: Patient
Coverage.payor.typeextensiblePattern: Organization
Coverage.class.typeextensibleCoverageClassCodes

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..*CoverageInsurance or medical plan or a payment agreement
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): IETF language tag

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... PlanYear 0..1stringUAPI Coverage Plan Year
URL: https://fhir.developer.gene.com/StructureDefinition/PlanYear
... ReferenceNumber 0..1stringUAPI Coverage Reference Number
URL: https://fhir.developer.gene.com/StructureDefinition/ReferenceNumber
... IssuedDate 0..1dateUAPI Coverage - Card issuance date
URL: https://fhir.developer.gene.com/StructureDefinition/IssuedDate
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for the coverage
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type SΣ1..1CodeableConceptCoverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber Σ1..1Reference(UAPI Patient | UAPI RelatedPerson)Subscriber to the policy
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringPatient or RelatedPerson resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... subscriberId SΣ0..1stringID assigned to the subscriber
... beneficiary Σ1..1Reference(UAPI Patient)Plan beneficiary
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringPatient resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Patient
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... dependent Σ0..1stringDependent number
... relationship 0..1CodeableConceptBeneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ0..1PeriodCoverage start and end dates
... payor Σ1..*Reference(UAPI Organization)Issuer of the policy
.... id 0..1idUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringPayor Orginization resource UUID
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible)
Required Pattern: Organization
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... class S1..*BackboneElementAdditional coverage classifications
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ1..1CodeableConceptType of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

..... id 0..1idUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ1..1CodingCode defined by a terminology system
...... id 0..1idUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
.... value Σ1..1stringValue associated with the type
.... name Σ1..1stringHuman readable description of the type and value
... order SΣ1..1positiveIntRelative order of the coverage
... network SΣ1..1stringInsurer network
... costToBeneficiary 0..*BackboneElementPatient payments for services/products
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type Σ0..1CodeableConceptCost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

.... value[x] Σ1..1The amount or percentage due from the beneficiary
..... valueQuantityQuantity(SimpleQuantity)
..... valueMoneyMoney
.... exception 0..*BackboneElementExceptions for patient payments
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type Σ1..1CodeableConceptException category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ0..1PeriodThe effective period of the exception
... subrogation 0..1booleanReimbursement to insurer
... contract 0..*Reference(Contract)Contract details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Coverage.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.statusrequiredFinancialResourceStatusCodes
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
Coverage.subscriber.typeextensibleResourceType
Coverage.beneficiary.typeextensiblePattern: Patient
Coverage.relationshipextensibleSubscriberRelationshipCodes
Coverage.payor.typeextensiblePattern: Organization
Coverage.class.typeextensibleCoverageClassCodes
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes

 

Other representations of profile: CSV, Excel, Schematron